Part of the book: Pain Management
Pediatric acute and chronic pain experiences involve the interaction of physiological, psychological, behavioural, developmental, pharmacological and situational factors. In the acute perioperative pain setting preventative multimodal analgesia is required to provide comfort and minimise the potential for “wind-up” and central sensitisation. When pain is recurrent, ongoing or chronic some children embark on a downward spiral of decreased physical, psychological and social functioning. The multidisciplinary team management approach is a well-established standard of care for children with complex chronic pain. Intravenous lidocaine has peripheral and central mediated analgesic, anti-inflammatory and anti-hyperalgesic properties. Intravenous lidocaine infusion therapy (IVLT) has been shown to be effective in the management of acute and chronic pain in adults. This chapter will present the rational for IVLT in pediatric pain management with emphasis on preventative multimodal therapy in acute pain and the multidisciplinary treatment approach in chronic pain. Large multi-centre randomised controlled trials are required to provide the evidence-base to confirm that IVLT is indeed an effective and safe treatment option in acute preventative multimodal analgesia and as an adjunct in the multidisciplinary care of chronic pain in the pediatric population.
Part of the book: Pain Relief
Chronic pain is a significant burden in all societies. The myofascial origins of chronic pain are often unrecognized but play a major role in chronic pain generation. Myofascial release has been shown to be effective and can augment the limited number of therapeutic tools available to manage chronic pain. However, there is no standardized approach that allows for comparative analysis of this technique. myoActivation® is a unique therapeutic system, which targets active myofascial trigger points, fascia in tension, and scars in patients with chronic pain. Targets for intervention are determined through obtaining a history of lifetime trauma and a structured, reproducible posture, and movement assessment. Catenated cycles of movement tests, palpation, and needling are used to achieve the goal of pain resolution through restoration of soft tissue integrity. This chapter describes the distinctive features of myoActivation from the important key elements of the patient’s clinical history, through to the aftercare instructions. Relevant evidence for each component will be presented. Case studies will be used to illustrate some important concepts and the effectiveness of myoActivation. This chapter is relevant to all clinicians that manage people living with chronic pain.
Part of the book: From Conventional to Innovative Approaches for Pain Treatment
Humans exhibit biotensegrity, whereby the whole body is a three-dimensional visco-elastic vehicle whatever position it adopts: bones form non-contact compression struts embedded in a networked and tensioned myofascial matrix; each part of the organism combines with the mechanical system to create an integrated functional movement unit and contributes to the stability of the whole system. When tissue at/below the dermis is breached by surgery/injury, healing leads to scar tissue formation. Scars can cause local and distant effects that are not purely cutaneous. Restriction of normal movement of underlying tissues from defective fascial sliding generates anomalous tension that affects the fascial continuum leading to distorted biomechanics, altered biotensegrity and chronic pain. Scars are common in children and significant contributors to chronic pain presentations. Scars can be released (soft tissue mobilization and/or needling) to sustainably improve pain, flexibility and range of motion. This chapter outlines the importance of skin and fascia in the biotensegrity model. Emphasis is placed on the fundamental need to assess scar history and scar characteristics to determine if scars should be treated as a component of multidisciplinary chronic pain management. Case studies outline some key clinical observations. Appropriately controlled research studies are required to fully demonstrate the highlighted benefits.
Part of the book: Pain Management